TY - JOUR
T1 - The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases
AU - Salazar, Michelle C.
AU - Canavan, Maureen E.
AU - Walters, Samantha L.
AU - Chilakamarry, Sitaram
AU - Ermer, Theresa
AU - Blasberg, Justin D.
AU - Yu, James B.
AU - Gross, Cary P.
AU - Boffa, Daniel J.
N1 - Funding Information:
This project was made possible by the Yale National Clinician Scholars Program and by CTSA grant no. TL1 TR001864 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NIH. We acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services, and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare Database. This study used the SEER-Medicare linked database.
Funding Information:
Disclosure: Dr. Yu reports receiving speaking and consulting fees for Boston Scientific and is a member of the advisory board for Galera Pharmaceuticals, unrelated to the present work. Dr. Gross reports receiving funding, paid to Yale University, from the NCCN Foundation (partly funded by Pfizer / AstraZeneca) ; research funding paid to Yale University from Johnson and Johnson, funding paid to Yale University from Genentech, funding paid to Yale University and Flatiron and travel/speaking reimbursement fees. Dr. Boffa runs assays for free through Epic Sciences, unrelated to the present work. The remaining authors declare no conflict of interest.
Publisher Copyright:
© 2021 The Authors
PY - 2021/3
Y1 - 2021/3
N2 - Introduction: Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy. Methods: A retrospective cohort study using the National Cancer Institute's Surveillance Epidemiology and End Results—Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005–2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE. Results: A total of 4560 patients (median age 74, interquartile range 70–78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52–1.86, p < 0.001). For those with CR-LE less than 5, there was no significant difference in mortality risk between lobectomy and wedge (hazard ratio: 1.19, 95% confidence interval: 0.96–1.47; p = 0.11). CR-LE less than five patients who underwent a lobectomy had higher 90-day mortality compared with wedge (9% versus 4%, p = 0.04). Conclusion: The survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non–cancer-related causes.
AB - Introduction: Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy. Methods: A retrospective cohort study using the National Cancer Institute's Surveillance Epidemiology and End Results—Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005–2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE. Results: A total of 4560 patients (median age 74, interquartile range 70–78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52–1.86, p < 0.001). For those with CR-LE less than 5, there was no significant difference in mortality risk between lobectomy and wedge (hazard ratio: 1.19, 95% confidence interval: 0.96–1.47; p = 0.11). CR-LE less than five patients who underwent a lobectomy had higher 90-day mortality compared with wedge (9% versus 4%, p = 0.04). Conclusion: The survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non–cancer-related causes.
KW - Lobectomy
KW - Mortality
KW - Non–small cell lung cancer
KW - Stage I
KW - Wedge
UR - http://www.scopus.com/inward/record.url?scp=85111547863&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111547863&partnerID=8YFLogxK
U2 - 10.1016/j.jtocrr.2021.100143
DO - 10.1016/j.jtocrr.2021.100143
M3 - Article
C2 - 34590002
AN - SCOPUS:85111547863
SN - 2666-3643
VL - 2
JO - JTO Clinical and Research Reports
JF - JTO Clinical and Research Reports
IS - 3
M1 - 100143
ER -